Many dementia patients might be misdiagnosed and undergoing unnecessary treatments, according to the preliminary results of a major study presented Wednesday at the Alzheimer's Association International Conference.
Researchers from the University of California-San Francisco's (UCSF) Memory and Aging Center in 2016 launched the Imaging Dementia-Evidence for Amyloid Scanning (IDEAS) study to determine:
- How amyloid positron emission tomography (PET) scans can help physicians treat mild cognitive impairment or dementia; and
- Whether using amyloid PET scans results in better medical outcomes for patients.
For the study, the researchers are conducting amyloid PET scans, which cost between $3,000 and $4,000 and usually are not covered by insurance, on more than 18,000 Medicare beneficiaries diagnosed with mild cognitive impairment or dementia to determine whether they have amyloid plaque. According to the Washington Post, the absence of amyloid plaque means an individual "definitely" does not have Alzheimer's disease, but the presence of amyloid plaque could mean an individual has Alzheimer's, because it precedes the disease in Alzheimer's patients and raises the risk of the disease's progression.
The researchers so far have performed amyloid PET scans on 4,000 Medicare beneficiaries, the Post reports. CMS agreed to reimburse the cost of PET scans for Medicare beneficiaries enrolled in the trial.
The researchers plan to collect and review the Medicare claims of the study participants for up to three years to see whether the PET scans resulted in physicians changing the beneficiaries' treatment plans and whether the scans had an effect on emergency department visits and hospitalizations.
The researchers found the results of the PET scans so far have led physicians to change their care plans for two-thirds of the Medicare beneficiaries who received the scans. Gil Rabinovici, who is leading the research, said most of those changes involved medications intended to temporarily reduce Alzheimer's symptoms.
According to the study, the PET scans researchers have completed so far revealed some Medicare beneficiaries with mild cognitive impairment or dementia who take medication to treat Alzheimer's might not have the disease.
The researchers found the presence of amyloid plaque among:
- 70.5 percent of Medicare beneficiaries diagnosed with dementia; and
- 54.3 percent of Medicare beneficiaries diagnosed with mild cognitive impairment.
James Hendrix, director of global science initiatives for the Alzheimer's Association who co-presented the preliminary findings, said they show "high percentages of people who are on a drug and didn't need to be on those drugs."
Rabinovici said without PET scans, providers are "not accurate enough." He added that many of the PET scans "effectively ruled out" Alzheimer's disease as a diagnosis, "so it's something else" (Bahrampour, Washington Post, 7/19; Neergaard, AP/ABC News, 7/19; UCSF Memory and Aging Center study summary, accessed 7/19; Alzheimer's Association Internal Conference release, 7/16).
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Over 5.3 million Americans currently suffer from Alzheimer’s disease and related memory disorders and the Alzheimer’s Association predicts this number to triple to 13.8 million by 2050. On top of rising demand, reimbursement processes fail to meet the complex needs of these patients who require multifaceted care.
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